Date of Award

Fall 1-10-2020

Degree Type


Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Ike Okosun, PhD

Second Advisor

J. Michael Bryan, PhD



The Differential Incidence of Gestational Hypertension Among Georgia Counties

Douglas G. Hoffmann, MD

October 31, 2019

INTRODUCTION: Gestational hypertension is responsible for a significant number of maternal mortality cases. It is hypothesized that county-level incidence differences of gestational hypertension in Georgia are related to county demographic or environmental characteristics and disease risk.

AIM: This study aims to determine factors related to differential incidence rates of gestational hypertension in Georgia.

METHODS: Data was obtained from the Georgia Department of Public Health and publicly available sources for the years 2013-2017. Gestational hypertension clusters were identified using GeoDa software. Contextual continuous variables were compared between the high-high and low-low clusters using the Mann-Whitney U test and categorical variables were compared using logistic regression.

RESULTS: The State of Georgia overall has a gestational hypertension rate of 54 per 1000 births, with county level 5-year average annual rates ranging from 16 to 200 per 1000 births. Georgia counties in the high-high cluster for gestational hypertension rate on geospatial analysis were associated with higher poverty, lower median household income, lower private health insurance coverage, lower population density, and higher age-adjusted death rates from COPD, ischemic heart disease, cerebrovascular disease, and all causes of death. The odds of a county being more rural were 6.13 times higher for those counties in the high-high cluster than those in the low-low cluster. Unemployment rate, proportion of white race, and proportion of black race were not associated with a differential rate of gestational hypertension.

DISCUSSION: This study reveals strong evidence that socioeconomic factors may be related to gestational hypertension, but does not infer causality of why some Georgia counties have higher rates of gestational hypertension compared to others. It also provides evidence that gestational hypertension rates may be used to identify counties that have higher mortality rates from various causes, and to inform public health officials of those counties in need of further intervention.


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